Provider Demographics
NPI:1184003568
Name:KOEHN, SANDRA (DO)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:KOEHN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 BUFFALO RD BLDG 800
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1360
Mailing Address - Country:US
Mailing Address - Phone:585-368-6370
Mailing Address - Fax:585-368-6371
Practice Address - Street 1:2300 BUFFALO RD BLDG 800
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624
Practice Address - Country:US
Practice Address - Phone:585-368-6370
Practice Address - Fax:585-368-6371
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294083207R00000X
MI5101021710390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine